Organization
LEE MEMORIAL HEALTH SYSTEM
Active
Other names
LCH-Peds PC#2
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH NIEBERGALL (CREDENTIALING SPECIALIST)
(239) 424-1446
Entity
Organization
Contact information
Practice address
2525 HARBOR BLVD STE 204, PORT CHARLOTTE, FL 33952-5342
(941) 629-2922
(941) 629-1311
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(941) 629-2922
(941) 629-1311
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
04/09/2020
Last updated
04/09/2020
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